What's the Best Way to Heal Foot Ulcers?

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Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers: a multicenter, randomized controlled trial, by Peter A. Blume and colleagues. Diabetes Care 31:631-636, 2008

What is the problem and what is known about it so far?

Foot ulcers are a common and disabling complication of diabetes. They can become chronic wounds that won't heal and are difficult to treat. Left untreated, they can lead to foot amputations. There are several treatments for diabetic foot ulcers, and their success depends on numerous factors, including how each treatment works, how well patients comply with treatment, whether the wound is properly cleaned and prepared before treatment, and whether measures are taken to relieve weight and stress to the injured foot.

Why did researchers do this particular study?

The researchers wanted to compare the safety and effectiveness of the two different types of treatment for diabetic foot ulcers.

Who was studied?

Subjects included 342 adult diabetic patients with significant foot ulcers at 37 North American diabetic foot and wound clinics and hospitals.

How was the study done?

Patients were randomly assigned to receive either negative pressure wound therapy (NPWT) or advanced moist wound therapy (AMWT). In NPWT, the wound is enclosed in padding and a foam dressing, then exposed to negative air pressure with a vacuum device to reduce swelling and promote new skin growth. AMWT involves applying medicated gels that encourage healing and skin growth.

What did the researchers find?

NPWT was just as safe as and more effective than AMWT. More NPWT patients had full wound closure (61%) than the AMWT patients (40%). In addition, healing took less time with NPWT, and NPWT subjects had fewer resulting amputations than AMWT subjects. There were no differences between the two therapies in terms of ulcer-related complications, such as infections.

What were the limitations of the study?

Although subjects were randomly assigned to one of the two treatments, neither patients nor researchers could be "blinded" to the type of therapy each patient received because the two therapies differed so greatly. Having patients and researchers know which type of therapy was being used may have influenced the results.

What are the implications of the study?

Treatment for foot ulcers involves several processes, including cleaning wounds, removing dead tissue, treating infections, restoring the blood supply to the wounded area, applying various therapies, and limiting weight and stress on the wound. NPWT, when used in conjunction with these other components of wound care, can help people with diabetic foot ulcers heal completely and avoid chronic foot problems, infections, and possible amputations.

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